This is a common perception. While many prostate cancer are slow growing, it is important to understand that, if given enough time, prostate cancers transition to a more fast growing process. Genetic changes at the DNA level (splicing mistakes and mutations) accumulate and result in cells with more DNA disorder. This can translate to a more aggressive cancer.

In my practice, I am seeing more men who are diagnosed with more extensive cancers. Whether this is due to decreased PSA screening is uncertain. I believe that men should speak with their primary physicians, particularly if they have a family history or are in a high risk group (i.e. African American heritage).

I believe there is a clear benefit to screening men with PSA. I also believe that politics and policy colors the recommendations of groups that discourage screening for cancer. I screen PSA for myself and I strongly recommend it to men in my family.

PSA screening was analyzed in two large trials. The European Randomized Study for Screening of Prostate Cancer (ERSPC) was published in 2008. This study was twice as large as a similar, but flawed, US trial. The European trial had longer follow-up, and was a much cleaner trial (no PSA screening prior to entry on the trial, better compliance in the screened group, much less PSA screening in supposed non-screened group). It showed a clear and convincing 20% reduction of cancer deaths by the use of PSA screening. The study conclusions showed that by screening men 55-69 with PSA and offering regular follow-up, an increase in early detection was found, resulting in decreased deaths from metastatic disease.

If prostate cancer is not successfully treated when confined to the prostate, it can spread to lymph nodes or into to the bones of your body. We call this type of progression metastatic disease. If that happens, pain and disability can occur which influence the quality of life. It can also cause problems that can alter the length of life. There was a study published in the New England Journal of Medicine in 2011 that compared men with treated prostate cancer versus men with cancer who were placed on an active surveillance protocol. There was a benefit in life expectancy in the treated group. However, everyone’s situation is different and having a honest discussion with a prostate cancer specialist can help you decide on the best course of action in your particular case.